根除幽门螺杆菌感染对慢性胃炎疗效影响的多中心临床研究

摘要

Objective To evaluate the influence of Helicobacter pylori (Hp) eradication on clinical manifestations, endoscopic features and pathological findings of chronic gastritis. Methods This was a multiple-center, prospective and randomized cohort study. Patients with non-atrophy chronic gastritis from January 2009 to December 2010 were randomized into 3 groups as Hp positive group with eradication, Hp positive group without eradication and Hp negative group. Clinical manifestations, endoscopic findings and pathologic changes of inflammation were compared before and after administration of gastric mucosal protective agent for 8 weeks. Results A total of 211 patients were recruited. Changes of symptom score, endoscopic erosion and mucosal inflammation were significantly different before and after treatment in 3 groups. The decrease in symptom scores of eradication group was ( 3.56 ± 1.37 ), which was significantly higher than that of non-eradication group (2. 80 ± 1.30, P ＜0. 01 ). The decrease of mucosal inflammation and inflammatory activity scores in eradicate group was 1.08 ± 1.34 and 1.42 ± 1.09, respectively, which were also significantly higher than those of the eradication group (0. 49 ± 1.47 and 0. 61 ± 1.34, P ＜0. 01 ). But the improvement of endoscopic erosion in 2 groups showed no significant difference. There were no significant differences in these variables between non-eradication group and Hp-negative group ( P ＞ 0. 05 ). Conclusion For chronic non-atrophic gastritis patients with positive Hp infection, combination of mucosal protective agents and Hp eradication can achieve better improvement in symptoms and gastric inflammation repair.%目的 探讨根除幽门螺杆菌(Hp)对慢性胃炎患者临床症状、内镜表现及病理改变的影响.方法 采用多中心、前瞻性、随机化对照研究,观察2009年1月至2010年12月间入组的慢性胃炎患者,分为Hp阳性根除组、Hp阳性不根除组和Hp阴性组,均予以8周的胃黏膜保护剂治疗,对比各组治疗前后临床症状、内镜下表现及病理炎症的变化.结果 共完成病例211例.经过8周治疗,3组治疗前后在症状总评分、内镜下糜烂、慢性炎症和炎症活动方面的变化均具有统计学意义.其中,根除组治疗前后症状评分的差值为(3.56±1.37),显著高于不根除组(2.80±1.30,P＜0.01).根除组治疗后胃黏膜慢性炎症和炎症活动的分值下降分别达到(1.08±1.34)和(1.42±1.09),亦显著高于未根除组(0.49±1.47和0.61±1.34,P＜0.01),但2组在内镜糜烂的改善上差异无统计学意义.不根除组和Hp阴性组之间在上述指标上的差异均无统计学意义(P＞0.05).结论 对于伴有Hp感染的慢性非萎缩性胃炎的患者,在应用胃黏膜保护剂的基础上,根除Hp有助于获得更好的症状改善和胃黏膜炎症修复.